Glasgow Prognostic Score As A Predictive Index For Postoperative Intra-abdominal Septic Complications After Surgery For Crohn's Disease

Aim and Background:Postoperative intra-abdominal septic complications(IASCs)are not uncommon in patients with Crohn's disease(CD).The appropriate index to predict the postoperative IASCs in patients with CD is still unknown.This study investigates whether the inflammation-based Glasgow prognostic score(GPS)has the ability to predict the postoperative IASCs in CD patients with elective bowel resection.Methods:A consecutive cohort of CD patients who underwent elective intestinal resection for CD between July 2012 and March 2016 were retrospectively analyzed.The GPS was defined by the seral level of C-reactive protein and albumin.According to the GPS score level,the patients were divided into 2 groups:the lower GPS group and the higher GPS group.Univariate and multivariate analyses were conducted to identify risk factors for postoperative IASCs.Results:According to the inclusion criteria,A total of 163 patients who underwent elective intestine resection for CD were included in our study.The higher GPS was associated with a higher postoperative IASCs(P<0.001)and a longer postoperative hospital stay(P=0.001).Compared with the the lower GPS group,patients with higher GPS had higher incidence of postoperative IASCs(9.85%VS 38.71%,P<0.001)and longer postoperative hospital stay(10.53±7.00 VS 15.71±9.17,P=0.001).Univariate analysis revealed that a higher GPS(P<0.001),Body mass index<18.5kg/m2(P=0.042),Albumin<35g/L(P=0.029),open surgical management(P<0.001),and penetrating disease characteristics(P<0.001)were associated with increased risk of postoperative IASCs.By the multivariate analyses,only the preoperative GPS[odds ratio(OR):5.016,95%confidence interval(CI):1.134-22.193,P=0.034]and penetrating behavior(OR:4.495,95%CI:1.377-14.670,P=0.013)were independent risk factors for postoperative IASCs.If the patients had neither a higher GPS or penetrating disease,the possibility of postoperative IASCs was 3.7%;in patients who had only one risk factor(either higher GPS or penetrating disease),the possibilities of postoperative IASCs were 14.3%and 16.7%,respectively;The incidence of postoperative IASCs was 58%if patients had both higher GPS and penetrating behavior at the time of surgery.Conclusions:Preoperative GPS can be served as an useful index to predict postoperative IASCs after bowel resection in patients with CD.Perioperative optimization is required to improve the postoperative outcome for patients with higher GPS.